The effects of oral care with 0.2% chlorhexidine with toothbrushing to prevent ventilator associated pneumonia in adults' intensive care units

Abstract

Background: Ventilator Associated Pneumonia (VAP) is the most common infection in Intensive Care Units (ICUs) which increases the length of ICU stay, duration of mechanical ventilation, and mortality. Good oral hygiene care by means of effective plaque control has thus been advocated as an essential nursing care to prevent colonization of dental plaque by respiratory pathogens, and possibly prevent VAP. Objective: This randomized controlled trial aimed to compare the incidence of VAP in mechanically ventilated patients treated with pharmacological (topical oral chlorhexidine) and combination (toothbrushing plus chlorhexidine) oral care. Methodology: A total of 63 mechanically ventilated patients treated at Hospital Universiti Sains Malaysia (USM) Intensive Care Unit (ICU) were randomly assigned into two groups: a control group of 32 patients who received 0.2% chlorhexidine gluconate mouthrinse twice daily and a study group of 31 patients who received 0.2% chlorhexidine gluconate mouthrinse twice daily plus tooth brushing. This study protocol was approved by the USM Human Research Ethics Committee. Results: Of 63 patients, 9 developed VAP, making the total incidence of VAP as 14.3%. Of these 9 patients who developed VAP, 6 were from the control group (18.8%, 95%CI: 6.8-40.1), and 3 were from the trial group (9.7%,95%CI:1.9-28.2). Conclusion: VAP was less likely to occur in the trial group than in the control group, indicating that tooth brushing twice daily in addition to standard care of 0.2% chlorhexidine gluconate mouth rinse was effective in reducing the incidence of VAP in mechanically ventilated patients treated at Hospital USM ICU